Use of traditional cigarettes fell, but e-cigs, hookah grow in popularity

Action Points

During 2011 -- 2015, substantial increases were observed in e-cigarette and hookah use among high school and middle school students, whereas significant decreases were observed in the use of cigarettes, cigars, smokeless tobacco, pipe tobacco, and bidis, resulting in no decline in tobacco use overall.

With increasing use of emerging tobacco products, including e-cigarettes, among middle and high school students it is critical that comprehensive tobacco control and prevention strategies for youths address all tobacco products, according to the CDC.

Use of nontraditional tobacco products, including e-cigarettes and hookah pipes, continues to rise among teens, stalling efforts to reduce overall tobacco use among high school and middle school students, federal officials reported.

In 2015, an estimated 4.7 million high school and middle school students reported current use of any tobacco product and almost half reported using at least two tobacco products, resulting in no decline in overall tobacco use among teens since 2011, according to Tushar Singh, MD, PhD, of the CDC in Atlanta, and colleagues.

However, one positive finding from the survey results, published in theMorbidity and Mortality Weekly Report, is that use of traditional cigarettes continued to decline among teens between 2011 and 2014, particularly the use of cigarettes, cigars, smokeless tobacco, pipe tobacco, and bidis. But there was no decline in tobacco use overall.

In the 2015 National Youth Tobacco Survey, e-cigarettes were the most commonly used tobacco product among teens for the second year in a row, with 16% of high school students, and 5.3% of middle school students reported current use of e-cigarettes.

Between 2011 and 2015, use of e-cigarettes increased from 1.5% to 16% among high school students and from 0.6% to 5.3% among middle school students surveyed.

"E-cigarettes are now the most commonly used tobacco product among youth, and use continues to climb," said Tom Frieden MD, CDC director, in a written statement. "No form of youth tobacco use is safe. Nicotine is an addictive drug and use during adolescence may cause lasting harm to brain development."

Erika Sward, assistant vice president of national advocacy, for the American Lung Association said the federal government's failure to regulate e-cigarettes and many other tobacco products is largely responsible for the rise in their use among teens.

It has been 2 years since the release of the FDA's proposed rules to regulate e-cigarettes, and 5 years since the FDA first announced plans to regulate cigars, e-cigarettes, little cigars and hookah, and these products remain unregulated, Sward said.

"Our nation is at a tipping point regarding whether or not we are going to continue the progress made starting in the mid-90s, or if we are going to fall backward with the increased use of these other tobacco products," she told MedPage Today. "We have clearly failed as a nation to apply the lessons learned from the battle against the cigarette industry to e-cigarettes and these other tobacco products."

Singh and colleagues pointed out that tobacco prevention and control strategies, including increasing tobacco product prices, adopting comprehensive smoke-free laws, and implementation of national public education media campaigns, likely have contributed to the reduction in use of certain tobacco products, including cigarettes, among youths in recent years."

But the increase in use of "emerging tobacco products," such as e-cigarettes, most likely offset that gain, they added.

Close to one in 10 high school students reported current use of cigarettes in the latest survey, making cigarettes the second most used tobacco product in this age group.

The survey found that between 2011 and 2015, a significant nonlinear increases occurred in the use among high school students of e-cigarettes (1.5% to 16%) and hookahs (4.1% to 7.2%).

Also in that time period, significant linear decreases were seen for current use of cigarettes among high school students (15.8% to 9.3%), along with smokeless tobacco products (7.9% to 6%).

Significant nonlinear declines were seen in cigar use (11.6% to 8.6%) and pipe tobacco (4% to 1%) among high school students.

Among middle school students, significant linear increases were reported for use of e-cigarettes (0.6% to 5.3%) and hookahs (1.0% to 2.0%).

Significant linear decreases among middle school students were seen for current use of cigarettes (4.3% to 2.3%), cigars (3.5% to 1.6%), and smokeless tobacco (2.7% to 1.8%).

Significant nonlinear decreases were observed for current use of pipe tobacco (2.2% to 0.4%).

Singh's group concluded that tobacco control efforts aimed at teens must include e-cigarettes and other tobacco products that are increasingly being used by this age group.

"Given that the use of e-cigarettes is on the rise among middle and high school students and nicotine exposure from any source is dangerous for youths, it is critical that comprehensive tobacco control and prevention strategies for youths address all tobacco products and not just cigarettes," they wrote.

The survey had some limitations. First, it was conducted with students at U.S. private and public schools so the findings might not be generalizable to youths who are home-schooled, have dropped out of school, or are in detention centers, the authors explained. Also, the data was self-reported so the findings are subject to recall and response bias.

Singh and co-authors disclosed no relevant relationships with industry.

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